Hi Colette and all.
 
Some thoughts and questions:
 
Is baby's weight being plotted on the WHO growth charts? 4 oz per week  
would be the bare minimum acceptable, but I think still is within normal  
limits.
 
Decrease in stooling frequency is not unusual after 6 wks. 
 
Pacifier use or thumb/finger sucking? I know my "slow to gain" baby found  
her thumb early on, and should have been put to breast more frequently. 
Sounds  like nursing every 30 minutes is the way your baby is getting enough  
calories to maintain growth. Using breast massage and compression during  
feeds?
 
Pumping about 10 minutes after most feeds (at least 8x in 24  hours) with a 
hospital grade pump, as well as taking the herbal galactogugues,  if milk 
supply is an issue?
 
Possibility of posterior tongue tie, or sub-mucosal frenulum or  limiting 
tongue function and mobility? Check out _www.tonguetieclipit.com_ 
(http://www.tonguetieclipit.com)  to learn how  to assess a tongue tie. "Interview with 
the Expert" video is quite informative.  I love the point Dr Murphy makes 
that the tongue should elevate at least halfway  and should have good 
peristaltic motion.
 
Has baby been checked for a sub-mucosal cleft of the hard or soft  palate?
 
Continued CST and suck training may be part of the treatment to improve  
milk transfer. I would recommend a NDT (neuro-developmentally  trained) 
occupational therapist to get evaluation of suck. How about infant  chiropractic 
as an adjunct to the CST?
 
I second the baby wearing and position changes if she has difficulty  
keeping up with a overactive MER.
 
Good luck and keep us posted on how things are going.
 
Mary-Jane Sackett, RN, BSN, IBCLC
Pittsfield, MA
 
 
 

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